CLL: Overall Treatment Savings With Ibrutinib (Imbruvica) Despite Higher Prescription Costs Interview with:

Dr. Sundaram

Murali Sundaram, MBA, Ph.D.
Director of Real World Value and Evidence
Oncology, Janssen What is the background for this study?

Response: Ibrutinib is a novel Bruton’s tyrosine kinase (BTK) inhibitor approved for the treatment of patients with newly diagnosed chronic lymphocytic leukemia (CLL).

Ibrutinib is administered orally while standard of care (CD20 monoclonal antibody-based chemoimmunotherapy [CIT]) is administered intravenously. This difference in route of administration impacts what type of benefit covers these treatments (i.e., pharmacy benefit for oral ibrutinib and medical benefit for intravenous CIT).

Previous studies evaluating the costs burden of patients treated with ibrutinib versus CIT did not include the full spectrum of real-world healthcare costs. What are the main findings? 

Response: Using a commercial insurance claims database, this study found that patients receiving ibrutinib as a first treatment for CLL had a longer period of time before initiating the next line of treatment than patients taking different medications for the same type of cancer.

After 24 months following first treatment initiation, 89% of patients initiated on ibrutinib did not initiate a new treatment, compared to 76% of the patients initiated on CIT. In addition, first line treatment with ibrutinib resulted in net monthly cost savings of greater than $3,700 for the specific health care payers that were included in this research. This monthly savings were driven by lower medical costs of more than $10,500 per patient per month which fully offset the approximately $6,800 higher pharmacy costs per patient per month associated with the use of ibrutinib compared to CIT. What should readers take away from your report?

Response: This real-world study adds to the efficacy results of the clinical trials, by finding that patients treated with ibrutinib had a longer period of time before initiating the next line of treatment, which can serve as a proxy for progression-free survival (PFS). From a payer’s perspective, the use of ibrutinib is associated with net monthly cost savings as compared to CIT. What recommendations do you have for future research as a result of this work? 

Response: The current study was conducted among a commercially-insured population. Further research is warranted to evaluate whether these findings are applicable in different populations (e.g., Medicare population).

It would also be interesting to see if these results hold in particular subgroups of the population with different disease characteristics (e.g., IGVH-mutated vs. IGVH-unmutated patients). Is there anything else you would like to add? 

Response: From a payer’s perspective, a thorough assessment of the economic implications of treating CLL with ibrutinib requires that total healthcare costs, including both medical and pharmacy costs, needs to be considered.

Citation: ASH18 abstract

Front-line Ibrutinib Treatment Is Associated with Longer Time to Next Treatment, Net Total Cost Reduction, and Lower Healthcare Resource Utilization Compared to Chemoimmunotherapy in Patients with Chronic Lymphocytic Leukemia

Song Wang, PhD1*, Bruno Emond, MSc2*, Hela Romdhani, PhD2*, Patrick Lefebvre, MA2*, Murali Sundaram, MBA, PhD1* and Anthony R Mato, MD3

Janssen Scientific Affairs, Horsham, PA
Analysis Group, Inc, Montreal, QC, Canada
Memorial Sloan Kettering Cancer Center, New York, NY

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Last Updated on December 2, 2018 by Marie Benz MD FAAD